In “Understanding audit authority of third-party payers,” Cindy Hartwell, dental benefits analyst at CDA Practice Support, explained how a dental benefit plan’s authority to audit charts and records is a very important if often overlooked component of contracting with a dental benefit plan. In this article, she discusses what happens when the plan’s findings from the audit result in a refund demand.

Benefit plans have started offering information through their own online portals. When these portals were first introduced, the information offered was insufficient at best and in most cases still required an office to call the plan with many unanswered questions. However, this is less the case today as many plans have worked to improve their portal functionality to better meet the needs of the dental community.

Greg Alterton is approaching his 16-year anniversary with CDA. He worked in the CDA Public Policy Division for 13 of those 16 years, where he was involved in developing dental benefits legislation sponsored by CDA. He has assisted individual members directly with their dental benefit issues while in Public Policy and during the past three years with CDA Practice Support. He retires from CDA at the end of 2017.

Demands from dental plans seeking refunds of previously paid claims are common, but they’re not all alike. Most refund demands are legitimate, and state law requires health care providers who have been overpaid to refund an overpayment within 30 days of notice. These overpayments typically result from plans paying on claims when the patient had fallen out of eligibility unbeknownst to the plan when payment was made. Other overpayments may result from mistakes of the dental plan or insurer itself.

Beginning in the New Year, and with the forthcoming issue of the CDA Update, the dental benefits column will host a semiregular series discussing basic dental benefit issues. The topics covered address questions that CDA Practice Support receives from dental offices and from local dental components. This first installment addresses proper billing for treatment provided by an associate and waiving of co-payments.

Recently, Practice Support has received questions about whether the dental plans that dentists are contracted with can dictate fees for treatment on procedures that the plans don’t cover. The answer can be found in CDA-sponsored legislation that became effective in 2011.

At the 2016 CDA Presents The Art and Science of Dentistry in San Francisco, CDA will engage in conversation with representatives of the dental benefits industry about the likely future direction of dental benefits, the payment policies that challenge dental practices today and the practical approaches in the dental office to successfully administer patients’ dental benefits.